Chronic Pain and Understanding How our Pain System Works

Pain is a natural and necessary part of the human experience. Although pain is often seen as a negative experience, it is an essential part of our built-in protection system. 

Acute pain is a normal response to injury. When you sprain your finger, ankle, neck or back, receptors in the tissues send information to your brain that something has changed. If your pain system determines that you need to pay attention to the injured body area to ensure that you stay safe, you will experience pain or other reactions to prevent movement. Without this pain experience, you might continue to use the injured body part too much and delay your recovery. 

The nervous system is so good at protecting us, we often experience quite significant pain even when no or very minor changes in our tissue have occurred. We have all experienced intense pain when we stub our toe. Generally, within a few moments the pain subsides, and we realize nothing has been damaged. Pain is often experienced as a warning that we almost caused damage.

Chronic pain is pain that persists longer than we would typically expect and it can significantly affect a person’s quality of life. When pain doesn’t resolve it can be partially explained as a sign that our pain system is still trying to protect us. In many cases the original tissue injury has generally recovered.  Unfortunately, the protective barrier that our pain system initially put in place continues to warn us to avoid movements and activities far sooner than the recovered tissue really now needs.

A thorough assessment with your health practitioner can determine whether your persistent pain is still signaling that something in your body requires further protection or needs to be examined more carefully. The body can repair many types of injuries but often the combination of stiffness and weakness and an over-protective pain system can make it feel like healing has not occurred. In many cases you can gradually increase your activity at a pace that does not “alarm” your built-in protective system and get back to a higher level of function. 

Pain is a complex experience that involves everything about us as humans. This includes the amount that our pain system is trying to protect us as well as our thoughts, emotions, fears, worries and past experiences. Information is transmitted from the site of injury to the spinal cord and then to the brain, where it is interpreted. In persistent pain, the pain system may predict that the tissue is still requiring a lot of protection and sometimes it ignores or misinterprets the information coming from the tissue that is signaling that healing and recovery has actually occurred. The response of the pain system can include physical and emotional reactions such as increased heart rate, sweating, anxiety, muscle guarding and pain.

The emotional component of the pain experience can be present to a larger or lesser degree in pain of any type. The pain experience is influenced by context. It may be easier to manage pain when doing something we enjoy, in a friendly, safe setting as compared to when we feel threatened or unsupported. Pain can keep us away from work, sports, hobbies and social interactions. This can affect our mood and energy and lead to fear and worry. These emotions can influence our pain system, increasing and prolonging pain. It is important to address both the physical and emotional aspects of persistent pain. 

There are a variety of approaches to managing persistent pain, including medication, injections, psychological support, and physiotherapy. It is important for individuals with persistent pain to work with their healthcare provider to develop a personalized treatment plan that addresses all aspects of their current pain experience.

Discover how physiotherapy can help manage your persistent pain

Physiotherapy is a specialized branch of healthcare that focuses on restoring movement and the management of pain. Physiotherapists provide a comprehensive assessment to identify the underlying causes of movement problems and pain. They listen carefully to your story and ask questions about your medical history, lifestyle, and physical abilities. Once the underlying components are identified, a physiotherapist can develop a personalized treatment plan that addresses the specific needs of the individual.

Physiotherapy management for persistent pain may include pain science education, advice on activity pacing, self-management techniques like muscle release and breathing, manual therapy and exercise. Manual therapy involves hands-on technique such as massage, stretching and joint mobilization. These techniques are designed to optimize movement in affected areas. Exercises are tailored to the individual’s specific needs and abilities. These exercises work to improve strength, flexibility, posture and control. Physiotherapists may also provide treatments such as acupuncture and dry needling. Acupuncture and dry needling both use fine needles that are inserted into specific points on the body to relax muscles and stimulate your natural built-in pain relief systems. 

Physiotherapists work together with other health practitioners including kinesiologists, registered massage therapists, occupational therapists, counselors, and medical doctors to utilize a team approach to manage all aspects of your pain experience. 

Key goals of physiotherapy include providing knowledge and tools that give individuals some control over the pain they are experiencing.  Persistent pain can be worrisome and can impact an individual’s ability to carry out daily activities. Physiotherapy can help you understand how your pain system functions while improving your mobility resulting in decreased pain and increased function.  Physiotherapists love to enable individuals to engage in activities that they may have previously found difficult or thought impossible, improving their quality of life. 

Pain relieving medication has its role and is managed by your doctor or pharmacist. Some people experience side effects and the amount of pain relief that medication provides may decrease in the long term. Physiotherapists can provide education, self management tools and exercises that can decrease the level of pain and help prevent large pain flare-ups. This may diminish the need for pain medication and decrease some of the associated side-effects.  

Physiotherapy has a lot to offer to help you better manage your persistent pain. It involves a range of tools including education, treatment techniques and exercises to improve function. Physiotherapy can be a standalone treatment or as part of a comprehensive treatment plan that includes other medical management, therapies, and psychological support. By working with a physiotherapist, individuals with persistent pain can improve their overall quality of life and reduce their reliance on medication to manage their symptoms.

John Howick, Physiotherapist and Owner of Kamloops Physiotherapy & Sports Injury Centre

(Adapted from Moseley, L. et al, Master Sessions , NOI Group 2022)

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